Older Adults’ Engagement in Meaningful Activities and Quality of Life During COVID-19: A Mixed-Methods Study

IMPORTANCE: Engagement in meaningful activities (EMA) is a central determinant of older adults' health and quality of life (QoL) and is a concern of occupational therapy. OBJECTIVE: To examine the impact of EMA on QoL among community-dwelling older adults during the COVID-19 pandemic and explore their subjective experiences of the pandemic's impact on their perceived health. DESIGN: Cross-sectional mixed-methods design (quantitative and qualitative). SETTING: Community-dwelling older adults during the fourth to sixth waves of the COVID-19 pandemic in Israel. PARTICIPANTS: Older adults (N = 302) age 65 and older not hospitalized in the last month. OUTCOMES AND MEASURES: Four questionnaires were used for the quantitative analysis: Engagement in Meaningful Activities Survey (EMAS), World Health Organization Quality of Life (WHOQOL-BREF), the four-item Patient Health Questionnaire for Anxiety and Depression, and a sociodemographic questionnaire. Three open-ended questions regarding COVID-19's impact on perceived health and QoL were analyzed qualitatively. RESULTS: EMAS scores correlated with perceived health and WHOQOL-BREF scores, explaining an additional 13% of the WHOQOL-BREF variance above and beyond sociodemographic and perceived health scores (which explained 47% of WHOQOL-BREF's variance). Four themes emerged from the structured tabular thematic approach for brief texts: changes in activities, mental and physical health changes, defining health and QoL through changes in participation, and COVID-19-associated environmental barriers. CONCLUSIONS AND RELEVANCE: EMA contributed significantly to older adults' QoL and perceived health during the pandemic and was also evident in participants' definitions of health and QoL via changes in their activities. Plain-Language Summary: This study provides insight into engagement in meaningful activities (EMA) as a potential way to improve the quality of life of older adults during times of crisis. The study examined the impact of EMA on quality of life among community-dwelling older adults during COVID-19. The authors used questionnaires to explore the older adults' experiences of the pandemic's effect on their health. The study broadens understanding of how COVID-19 affected activity patterns among older adults, including changes in the frequency and manner of their engagement in various activities, as well as EMA's impact on how they perceived their health and quality of life.